Bottom Line:
A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula.Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events.With success, the time from the procedure to discharge was about 3 days (median).

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.

Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.

Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).

Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

Figure 3: Case 8. A 27-year-old male patient who had spontaneous pneumothorax, first episode. High resolution computed tomography showed multiple bullae and blebs in left apex (not shown). Two days after wedge resection with bullae and blebs plication (A), 1, 2, and 5 days after ethanolamine injection therapy (B~D).

Mentions:
As bronchoscopic ethanolamine injection therapy can be conducted under local anesthesia, light anesthesia or analgesics, it can avert risks associated with general anesthesia. Small amounts of over-flowed ethanol induced coughing, chest discomfort, and fever, but no serious respiratory complications such as hypoxia occurred during ethanolamine injection therapy. As radiologic opacities were shown in 8 patients (53.3%), ethanolamine-induced pneumonia was suspected. However, they were spontaneously resolved within 2~3 days (case 10) (Figure 3B~D). This was likely to be attributable to the regional edema due to ethanolamine injection5,7.

Figure 3: Case 8. A 27-year-old male patient who had spontaneous pneumothorax, first episode. High resolution computed tomography showed multiple bullae and blebs in left apex (not shown). Two days after wedge resection with bullae and blebs plication (A), 1, 2, and 5 days after ethanolamine injection therapy (B~D).

Mentions:
As bronchoscopic ethanolamine injection therapy can be conducted under local anesthesia, light anesthesia or analgesics, it can avert risks associated with general anesthesia. Small amounts of over-flowed ethanol induced coughing, chest discomfort, and fever, but no serious respiratory complications such as hypoxia occurred during ethanolamine injection therapy. As radiologic opacities were shown in 8 patients (53.3%), ethanolamine-induced pneumonia was suspected. However, they were spontaneously resolved within 2~3 days (case 10) (Figure 3B~D). This was likely to be attributable to the regional edema due to ethanolamine injection5,7.

Bottom Line:
A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula.Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events.With success, the time from the procedure to discharge was about 3 days (median).

Affiliation:
Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.

Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.

Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).

Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.